DHS ANALYTICAL STUDIES 39 - The DHS Program .DHS ANALYTICAL STUDIES 39 ... The DHS Analytical Studies

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DHS ANALYTICAL STUDIES 39

PREVENTING MalaRIa DURING PREGNaNcy IN SUb-SahaRaN afRIca:DETERMINaNTS of EffEcTIVE IPTp DElIVERy

SEPTEMbER 2013

This publication was produced for review by the United States Agency for International Development. It was prepared by Lia Florey of ICF International, Calverton, Maryland, USA.

MEASURE DHS assists countries worldwide in the collection and use of data to monitor and evaluate population, health, and nutrition programs. Additional information about the MEASURE DHS project can be obtained by contacting MEASURE DHS, ICF International, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (telephone: 301-572-0200; fax: 301-572-0999; e-mail: reports@measuredhs.com; internet: www.measuredhs.com).

The main objectives of the MEASURE DHS project are: to provide decision-makers in survey countries with information useful for informed policy choices to expand the international population and health database to advance survey methodology and to develop in participating countries the skills and resources necessary to conduct high-quality demographic

and health surveys

DHS Analytical Studies No. 39

Preventing Malaria during Pregnancy in Sub-Saharan Africa:

Determinants of Effective IPTp Delivery

Lia Florey

ICF International

Calverton, Maryland, USA

September 2013

Corresponding author: Lia Florey, International Health and Development, ICF International, 11785 Beltsville Drive, Calverton, Maryland 20705, USA; Phone: +1 301-572-0922; Fax: +1 301-572-099; E-mail: Lia.Florey@icfi.com

Acknowledgment: The author would like to thank Cameron Taylor for her invaluable assistance in producing maps and figures, Jessica Yi for help formatting tables, and Erin Eckert and Julie Gutman for expert advice, and guidance on methods and presentation. Rebecca Winter, Cameron Taylor, Erin Eckert and Susan Youll also provided invaluable feedback. Editor: Ward Rinehart, Jura Editorial Services Document Production: Yuan Cheng This study was carried out with support provided by the United States Agency for International Development (USAID) through the MEASURE DHS project (#GPO-C-00-08-00008-00). The views expressed are those of the authors and do not necessarily reflect the views of USAID or the United States Government. Recommended citation: Florey, Lia. 2013. Preventing Malaria during Pregnancy in Sub-Saharan Africa: Determinants of Effective IPTp Delivery. DHS Analytical Studies No. 39. Calverton, Maryland, USA: ICF International.

iii

Contents

List of Tables ............................................................................................................................................... v

List of Figures ............................................................................................................................................. vi

Preface ........................................................................................................................................................ vii

Executive Summary ................................................................................................................................... ix

Introduction ................................................................................................................................................. 1

Methods ........................................................................................................................................................ 5

Data ...................................................................................................................................................... 5

Variables ............................................................................................................................................... 7

Analyses ................................................................................................................................................ 9

Results ........................................................................................................................................................ 13

Descriptive Analyses ........................................................................................................................... 13

Descriptive AnalysesAntenatal Care ............................................................................................... 15

Descriptive AnalysesIPTp Coverage ............................................................................................... 20

Service Effectiveness Analyses ............................................................................................................ 23

Determinants of IPTp .......................................................................................................................... 25

Comparative Analyses of Lower and Higher IPTp Coverage Countries ............................................ 31

Discussion .................................................................................................................................................. 35

References .................................................................................................................................................. 39

Appendix .................................................................................................................................................... 43

v

List of Tables

Table 1. Information on populations included in analyses: survey information, national population size, sample size of target populations ......................................................................................... 5

Table 2. Basic information on variables included in analyses .................................................................... 8

Table 3. Percent distribution of socioeconomic, demographic, and health variables in recently pregnant women age 15-49 years from multi-country, pooled survey data ............................... 13

Table 4. Percent distribution of ANC care seeking and service variables among recently pregnant women age 15-49 years who made at least one ANC visit, from multi-country, pooled survey data .................................................................................................................................. 15

Table 5. Mean number of ANC visits among recently pregnant women age 15-49 years who made at least one ANC visit, by survey ............................................................................................... 18

Table 6. Mean months of gestation at first ANC visit among recently pregnant women age 15-49 years who made at least one ANC visit, by survey .................................................................... 19

Table 7. Stepwise summary of service effectiveness of malaria in pregnancy interventions (IPTp and ITN use by pregnant women), stratified by lower IPTp coverage and higher IPTp coverage surveys ......................................................................................................................... 25

Table 8. Results of pooled, univariate and adjusted, multivariable logistic regression models of IPTp1 use among women age 15-49 years with a live birth in the past two years who made at least one ANC visit during the most recent pregnancy ........................................................... 27

Table 9. Results of pooled, univariate and adjusted, multivariable logistic regression models of IPTp2 use among women age 15-49 years with a live birth in the past two years who made at least one ANC visit during the most recent pregnancy ........................................................... 29

Table 10. Comparing groups of higher and lower IPTp coverage countries by percent distributions of health intervention and ANC service-related determinants of IPTp2 among recently pregnant women age 15-49 years who made at least one ANC visit .......................................... 32

Table A.1. Percentage of recently pregnant women age 15-49 years who made at least one, at least two, and at least four ANC visits, by survey .............................................................................. 44

Table A.2. Percentage of recently pregnant women age 15-49 years who made at least one ANC visit, by number of ANC visits and by survey ............................................................................ 45

Table A.3. Percentage of recently pregnant women age 15-49 years who made at least one ANC visit, by timing of first ANC visit and by survey........................................................................ 46

Table A.4. Percentage of recently pregnant women age 15-49 years who took SP, by dose, by survey, and by higher and lower IPTp coverage countries ......................................................... 47

vi

List of Figures

Figure 1. Service effectiveness framework for IPTp, adapted from Tanahashi, 1978 ................................. 3

Figure 2. Conceptual framework: Factors influencing effective delivery of interventions to prevent malaria in pregnancy .................................................................................................................... 4

Figure 3. Countries with survey data included in analyses .......................................................................... 6

Figure 4. Standard IPTp questions from nationally representative household surveys (DHS/MIS) .......... 10

Figure 5. F